Pa. governor introduces opioid guidelines for comp

Five months after efforts to establish a drug formulary for injured workers in Pennsylvania failed, Gov. Tom Wolf introduced opioid prescription guidelines to “help health care providers determine when opioids are appropriate for treatment of someone injured on the job,” the governor’s office announced Monday.

The seven-page booklet includes details about opioid overprescription and urges medical professionals to proceed with caution. It is among 11 guideline booklets created by the state to address opioid prescription in different fields, including dentistry and pediatrics, for example.

The guidelines do not limit opioids, as state law enacted in 2016 already limits first-fill prescriptions to seven days, but instead urges a nonpharmacological approach. However, if pain relief is necessary “in most instances, acute workplace injuries are benign, self-limiting conditions and any associated pain is easily managed with non-opioid preparations such as acetaminophen or non-steroidal anti-inflammatory drugs,” the guidelines state.

If opioids are necessary, the guidelines encourage physicians to conduct a full medical evaluation, which includes a urine screen and counseling.

The guidelines also address long-term use of opioids: “Opioids should be continued only if clinically meaningful improvements are observed, and the patient is not experiencing unacceptable adverse effects. In most patients, opioids should not be abruptly discontinued, but rather should be slowly tapered. Tapering plans should be individualized and should minimize symptoms of withdrawal.”

The guidelines also address other medicines often prescribed in comp, urging providers to limit muscle relaxers to a one-week prescription in most cases and to avoid the deadline combination of benzodiazepines and opioids.